Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Spangles on March 03, 2014, 07:46:33 AM
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Hi Ladies
I've not posted for a while, I am currently on long cycle HRT, this consists of 13 weeks of Evorel 50 patch, and adding 5mg of Norethisterone for the last 2 weeks.
On the whole I haven't felt too bad, I've has a few ups and downs with my mood stc, but I think this is to be expected.
I'm due to start the Norethisterone on two days so I am expecting some changes then.
I suppose what I am asking is have any of you used this regime and if so what was your experience?
I'm hoping I tolerate the progesterone ok because if I do I will see if I can stay with it for another 3 months.
Any thoughts or advice will be very appreciated.
Thanks
Shellb
xXx
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Not quite sure of the timescales here - you say you are long cycle HRT but have you just started this long cycle because your question suggests you have never been through a full 3-month cycle yet?
Is this a change of regime from a different one?
I was on long cycle HRT for over 4 years but for the last year have dropped from a 12 week cycle to 8 weeks and am now reducing the cycle more because of heavy bleeding and period pain.
I don't think anyone can predict how you will get on with Norethisterone. It's very individual! I didn't take it for 14 days- my consultant prescribed 10 days per cycle and said I could get away with 8-9 days if the side effects were bad. During this time I've had regular scans at least once a year ( not NHS) and my lining was normal for someone on HRT.
I can tell I'm taking Norethisterone- I get a bit more bad tempered like PMS- I usually put on 1-2lbs which disappear once the bleeding starts and my bladder is sensitive to progestogens so I have a bit more frequency some days.
However, none of the above were so bad that I'd call it a problem.
I have now changed to Utrogestan because it may be safer re. breast cancer and as I hope to be on HRT long term, then I feel happier with it.
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Sarah2 & Shellb - I was on Oestrogel with Noresthisterone 10 days every month for many years through peri and post meno. I got horrible period pains with every withdrawal bleed and this together with all the scares about HRT back in 2002 made me decide to come off HRT at 49. I went back on HRT at 53 (still suffering dreadful meno symptoms) and ended up with a Mirena and Oestrogel - which was OK but I think the Mirena gave me fatigue.
I'm not on systemic HRT at the moment and my meno symptoms are not that bad but I'm really struggling with a painful Urethra (Vagifem not really helping) and may have to go back on full HRT. I would be interested if you get pain with the withdrawal bleed on Utrogestan?? DG x
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DG- I had terrible pain by the third cycle on Utrogestan, using it every 8 weeks. The first couple of cycles were about the same as on Norethisterone.
I am now going to try- on my consultant's advice- a semi-continuous regime of 21 out of 28 days on Utrogestan then hopefully a light bleed. I am not keen on this as I prefer proper 'cycles' so am going to experiment and see how it goes and maybe reduce the days on Utrogestan. What I am worried about is breakthrough or erratic bleeding because although Noerthisterone did give me painful bleeds they were very predictable each cycle.
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I used to be on a long cycle which was great, but I started getting breakthrough bleeds and my lining was quite thick (7mm). So now on a monthly regime, and I have noticed that my withdrawal bleeds are quite heavy to start with but my reasoning is, that there must be quite a lot of lining buildup to come away, having been on a long cycle for a few years, will see what the scan says later this year. The main thing is if you are going to use the progestegin/progesterone less frequently, to keep an eye, with an annual scan on how your uterus is looking as you want to avoid endometrial thickening...
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Cassie- I've always assumed that the lining was shed at the end of each cycle and started all over again so having had long cycles previously ought not to mean there is still a legacy of a thicker lining now.
When I've had scans I always scheduled them for just after a bleed- maybe day 7 or something- and the only scan I had that was later in the cycle- week 7- showed a slight increase in thickness.
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The lining will only all be shed if sufficient progestogen has been taken as it is all dose dependent. Therefore I imagine if there has been insufficient progestgoen, some of the lining will remain - and this could mean that either it will gradually thicken and/or come away sporadically as oestrogen breakthrough bleeding - just surmising here.
I have never been on a very long cycle - the longest for me has been 2 months as I didn't want to risk and overthickened lining nor a big bleed, nor possible build of of fibroids - but I take Utrogestan not norethisterone. My lovely female doc at the practice has given me some norethisterone which she suggested I take twice a year to have a good clear-out (as she put it) of my lining, in case of build up, but as it gave me headaches when I had it in patch form (Evorel sequi) it is still in the drawer!
Hurdity x
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Thanks for all the info ladies
I saw the doctor today and she has decided to keep me on this cycle for a while. I did mention Utrogestan as an alternative to Norethisterone and she said that what I was on was the last resort as she had given me all the options possible, she also said she had not heard of Utrogetstan!!!
Honestly GP's really do make me wonder sometimes!
xXx
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That sounds very unhelpful of her!
When you say last resort, have you tried lots of other kinds of HRT?
In any case, there are usually other options so she is being unhelpful.
How much better if she'd said she didn't know about Utrogestan but would be happy to find out.
She must be quite ignorant as Utrogestan is a common drug used in fertility treatments.
Do you have the chance to change GPs?
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Thats a good idea Hurdity, I wouldnt mind a good clear out twice a year, certainly less invasive than having a D&C but will see how I go on the monthly regime, & after my scan will know whether my Utro dosage is working as it should do. :)
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Just seen my post and I was very tired yesterday - I meant once a year not twice! That should be more bearable though I still haven't found the right time - where I don't mind feeling rubbish for a fortnight!
Sorry to hear that Shellb. However if you can tolerate it norethisterone is a very powerful progestogen and will probably work better on your lining for a long cycle. Fingers crossed you are OK with it!
Hurdity x
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Hi Hurdity what are the main symptoms/side effects when taking Norethisterone? Am just interested... thx
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It affects women in different ways and for some I think it has no effect at all! It gave me bad headaches/migraine (used transdermally). I think it can cause irritability low mood/PMS feelings too, as well as bloating - but it depends so much on the individual.
Hurdity x
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Thanks Ladies
I really appreciate all of your comments, I have posted a new question about too much progesterone! There are always so many questions, I am really beginning to resent the menopause, does anyone else feel this way?
Thanks
Shellb
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I think we all do Shellb - that's why we're here ;D
Hurdity x
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Hi Ladies
I've just completed my first 3 month cycle and still no bleed! I'm not complaining but it's 7 months now. I did think the progesterone would give me a bleed but it hasn't. What does this mean I wonder? Today I feel like just stopping the HRT to see what happens but I daren't. Do you have to get doctors advice to stop or can you do it yourself?
Thanks
Shellb
xXx
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How long is it since you took the last Norethisterone tablet?
It can take anywhere from 2-5 days for the bleed to start after taking the last tablet.
When you say it's 7 months since you had a bleed, does this mean you have had no bleeding with the previous cycle either?
Or do you mean this is your 1st 3 month cycle on HRT and you had no periods for 4 months prior to this?
Why do you feel like stopping HRT? Is it not suiting you?
You ought not to stop suddenly. For a start you may get symptoms quite badly- my gynae says it should be reduced over 6 months- and the other reason is that you always need to stop after a bleed so that the lining is thin.
It's possible that the oestrogen you are using has not been enough to thicken the lining enough to come away, though I'd say this is unlikely on a 50mg patch over 3 months.
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Hi Sarah
I had no bleed for 4 months then I had 3months on long cycle still no bleed so that has taken it to 7 months. I just wonder sometimes if I would be better with or without HRT.
xXx
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I'm still not sure what you are wanting advice on. Is it whether you should now have a bleed- or come off HRT? These are 2 different questions.
How long is it since you took the last Norethisterone tablet?
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Sorry
I was wondering if I should be having a bleed and also wondering how I would go about coming off hrt.
I took the last norethisterone yesterday.
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Dear Hurdity and Sara2
I am a bit confused about the long cycle HRT and the issue of preventing the risk of over thickened the endometrium lining. I was told that my lining of 7mm (it is now 2mm) was thick and due to the Tibolone I took for a while, and not the Tridesra long cycle which I took for much much longer.
Does the fact that the lining is shed on the bleed prevent the risk of thickening of the endometrium lining as it is shed via the bleed? If not, I wouldn't want to go back to Tridestra for anything but a short time to a process of elimination to establish my problem is meno related or something else.
LubyLou
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shellb- the bleed does not usually come for at least 2 days and anywhere up to 5 days after the last tablet- there is plenty of time for it to happen.
If you want to come off HRT then you ought to stop all oestrogen at the same time as you take the last Norethisterone otherwise the oestrogen will continue to build up your lining and it won't be shed if you don't take any more progestin. Best to check with your dr.
Luby- as far as I know the amount of progestins taken does 2 things- keeps the lining from building up indefinitely because it affects the oestrogen receptors in the uterus and sheds it once it's stopped ( in a cycle.) I assumed- but again am not sure- that all the lining was shed at the end of each cycle, but maybe there is a residual level which stays even though there has been a bleed.
My lining has always been 6mm on long cycle HRT ( thicker at the end of a cycle - 7mm) and my gynae felt this was acceptable. I've had 2 biopsies with a lining of 6mm and it was normal ( touch wood!)
I understand from the scans I've had that it's not just the thickness that is the issue, but how the lining looks - is it uniform and without any irregularities for instance. I read somewhere that a lining of up to 10mm is acceptable on women using sequential HRT- but don't quote me on that.
I don't know what effect Tibolone has compared to Tridestra- sorry. I'd have thought in theory that Tibolone was less likely to give you a thicker lining because it has androgenic properties as well- but I don't know.
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Hi lubylou
I commented on your other thread before I saw this one - was out all day/eve yesterday!
The point is (as I said on the other thread) if your lining thickens on a conti HRT the progestogen is not doing its job so this could be a worry because of the potential for endometrial hyperplasia and possible cancer. If over-thickening does occur then women can get oestrogen breakthough bleeding but not always ie it could thicken by a considerable amount before this happens I understand.
Clearly in a cycle the lining goes through the cycle of growing - proliferative (oestrogen), to secretory (when the progestogen is added) and then shedding. As I mentioned below ( I think - can't see my post - must be on the other page) the progestogen acts on the oestrogen primed uterus lining in a dose dependent manner so all the lining (that has grown due to oestrogen) is not necessarily shed each time if the dose of progestogen is not sufficient relative to the oestrogen. It should be (shed), because the doses of progestogen are calculated to be more than sufficient - but we are all individual and there are bound to be one or two women for whom it doesn't work exactly as it should.
Sarah - the endometrium is made up of different layers of cells. The biology of it all is quite complex!
Therefore lubylou you are asking different things - it would be much more of a worry to get an over-thickened lining on a conti HRT, but cyclical thickening on a cyclical HRT is normal, and the way to test for over-thickening in this case would be following a bleed when the lining has been shed - ie scan the thickness of the residual lining.
As I think I mentioend Tibolone is associated with some increased risk of endometrial hyperplasia - the manufacturer's information states this:
Endometrial cancer
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The available data from clinical trials are conflicting, however, observational studies suggest that women who are prescribed tibolone in normal clinical practice may be at an increased risk of having endometrial cancer diagnosed. The risk increases with increasing duration of use but shows no significant increase during the first 2-3 years of use (see section ADVERSE REACTIONS). Tibolone increases endometrial wall thickness, as measured by transvaginal ultrasound.
I hope this helps!
Hurdity x
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Resent it...I bloody hate it ;D
Scuse the language ladies but I could not think of another word.....Well I could but it was way way worse. ::)
Honeyb
x
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Dear Sara2
Knowledgably put as always, thanks for the info. My GP wasn't concerned about a 7mm lining, I think this may have been as a result of the time I was changed to Tiboline (continuous witt no bleed) and he put me back on Tridesta I assume his thinking was that my lining would shed on Tridesta and the thickening lining would reduce, but I am not sure and he has retired so I cannot ask him!
I was told the regularity of the lining is important, fortunatly all the scans I have had say my lining is both thin and regular in appearance.
Are you on an HRT with a bleed? I hope you don't mind me asking.
Hurdity, more knowledgeable information – I don't think my brain can keep up! I am beginning to get a much better overview of things and this is helping me so very much.
Big thank you :)
Lubylou
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luby- Yes I am on a regime with a bleed and have been for 5.5 years (I am now 59). This was the regime my consultant advised when I began HRT and it is one which I have continued with.
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Morning ladies,
After 7 months I finally got a period last night! It has totally floored me, the pain in my back legs and tummy is probably some other worse I have ever had, not to mention the nausea, feeling shakey and a little anxious.
I really had forgotten what it was like. I'm gutted now though as I believe I have to start counting towards 1 year again, is this true? I actually feel very teary and a little low now.
:'(
Shellb
xXx
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Isn't a long cycle hrt designed to give you a bleed Shellb? Once you start on a bleed HRT then there is no point in trying to go a year without a period as you are giving yourself oestrogen and progesterone which overrides your cycle if you still have one.
Taz x
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'Long cycle' means you will have a cycle- a bleed.
This is different from saying your own periods stop and you are classed as 'post menopause' a year after having no natural periods .
The only way you will not have a bleed is if a) you are on a continuous combined HRT ( oestrogen and a progestin daily) or b) you don't take any HRT and are post menopausal naturally.
See this info here from the green menu on the left
http://www.menopausematters.co.uk/postmeno.php
You can't have bleed-free HRT unless you are either over 54 or have not had a natural period for at least 12 months.
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Thanks ladies
I am so confused, how will I ever know if my periods have naturally stopped or not, when I started using HRT I hadn't had a bleed for 4 months, I know this isn't a year. I was surprised to get a bleed after 7 months though and yes I do understand that my HRT is designed to cause a bleed, prior tot his I was using femseven sequi and had no bleed at all on that for 4 months. This has progesterone and oestrogen in too so it's all completely baffling me. I'm so sorry if i sound silly but this whole meno thing confuses me more the further I get into it!
Thanks
Shellb
xXx
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The quick answer is you won't know if your natural periods have stopped while you take HRT unless you have cycles which may override the HRT and give you irregular bleeding.
I don't understand why you didn't have a bleed on your previous brand of HRT because it's sequential and designed to give a bleed. Did you ever follow this up with your dr then?
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Yes I did Sarah and she said it was probably because my periods had naturally stopped, hence the long cycle which she put me on. The idea was that if I still didn't have a bleed she would then switch me to a conti regime. Like I say I'm finding it all confusing.
xXx
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I think it's your dr who is confused!
She doesn't seem to understand what she is prescribing.
Long cycle HRT is usually for women who are having irregular but 'natural' periods during peri. Having said that, some consultants ( mine) prefer it for even older women ( post meno) for various reasons (and i do too.)
But the usual regime is monthly or longer sequential cycles in peri meno for women who are having periods, and then continuous regime ( with no bleeding) for women whose periods have stopped for at least a year or who are over 54 years old.
I really do think your dr is confused.
One of the first questions my consultant asks me at each appt is whether I have a scheduled bleed as expected. If I wasn't, then he would want to know why and adjust the HRT in some way.
If you are not post meno ( and you won't be if it's only 4 months since your last natural period OR you are under 54) then you can only have sequential HRT- this means you can either have a monthly bleed, or long cycle like the one you have just had. If the pain was really bad then it might be worth going back to a monthly or even a 6 week or 8 week regime which may give less bleeding and less pain.
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Hi Sara2 (and anyone else who can help with this)
When you say that some consultants ( mine) prefer it for even older women ( post meno) for various reasons (and i do too.) , can you say what these reasons are? I am asking because I am going back to my GP because the higher dose Premique isn't working for me and so I want to go back onto Tridestra (bleed every three months) which did work for me and I was one before I stopped HRT (I was on Tiboline for a while but I had breakthrough bleeding so previous and now retired GP put me back on Tridesra. The only reason I stopped was to see if my endometruim lining shrunk down from 7mm (it shrunk to 2mm in just over 6 months off HRT). I have already posted about my HRT chronology!
So any information I can give my GP about a post meno woman being on a long cycle HRT would be really helpful. I am getting more and more frustrated because with my life being on “hold due†to the constant furnace and sleep deprivation every night which means I cannot function well in the day. I want to go back on something that I know has worked effectively. Premique has never got rid of symptoms just made them more bearable and I had hoped that I would be able to reduce and get off and be symptom free. That has not happened in fact my symtoms are much worse now :'( If the Tridestra (or even another trial of Tibolone) does not work them I don't know what to do. I was able to take these two HRTs and be symptom free and they didn't interact in any way with my other essential daily medications. I hope that makes sense.
I am not sure if I could face a trial of another HRT which I haven't used successfully before.
Thanking you in anticipation
Lubylou
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Hi Lubylou
I think it is always hard for a patient to tell a dr what another dr is doing because it is one professional opinion over another- though of course one would assume that a GP might credit a consultant who has menopause as a special interest with greater knowledge.
I can only tell you what my experience is. It may not be the same as other people's!
I was put on Oestrogel because my consultant likes it- for ease of altering the dose and because it is bioidentical unlike oestrogen made with mares' urine (CEE.) You can use a tiny amount of less than 1 pump, or up to 4 pumps daily- whatever controls your symptoms. I was told to experiment with about a quarter of a pump and increase it gradually until I had symptom control.
The other reason for a long cycle is that there is research appears to show that high amounts of synthetic progestogens ( anything except natural micronised progesterone) are associated with more cases of breast cancer. It has been known for a long time ( since the MW and WHI studies) that women on combined HRT- ie oestrogen and progestogen- have more breast cancer than women who use oestrogen only.
There are now some studies which show that taking continuous HRT with a synthetic progestogen gives the highest risk of any combination.
For this reason my consultant prefers to use sequential HRT not continuous, because the amount of progestogens are kept low. This gives a slightly higher risk of endometrial cancer but the upside is that breast cancer risk is probably lower.
It also depends on what women want. some women do not want a period/bleed at any cost and will prefer to have continuous HRT and not care about any increased risks.
I don't know if this helps and many GPs may be reluctant to move away from standard practise - which says women over 54 or post meno should be on continuous combined HRT. Obviously consultants who are not working in the NHS have greater flexibility.
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Hi Shellb
Just to clarify re your confusion over why you got a bleed
You are on long cycle HRT ie oestrogen only for 10 weeks
Oestrogen builds up the lining of the uterus in a dose-dependent way ie the more oestrogen you have the thicker the lining will get.
You didnt get a bleed on the Femseven because presumably the lining did not build up sufficiently during the two weeks of oestrogen only, and then the progestogen in the second patch was sufficient to "thin" the lining already there.
In every woman the uterus lining will grow in the 10 weeks of the loing cycle and must be shed. I am very surprised if your GP did not explain this, so don't worry! It will also likely be heavier, again because of the increased build up - so if it is too heavy (for comfort or otherwise) the cycle would need to be shortened.
Lubylou - consultants do not prefer long cycles (ie 3 months) - well maybe one or two, in fact many actively dislike them due to the risk of endometrial hyperplasia. Maybe a prviate consultant might allow this - but that's because women are paying and can pay for the extra scans that might be necessary. On the NHS it is not usually recommended except under exceptional circumstances. Many women have problems on long cycles due to over stimulation with oestrogen causing breakthrough bleeding.
However many women and some consultants, prefer to continue to have cyclical HRT even after psot-menopause, either because of progesterone intolerance, or to keep progestogens to a minimum because of the research linking this with breast cancer (I think in the WHI study the incidence of BC was higher in the oestrogen/progestogen group than with oestrogen only). That's it really!
I was on an 2 month cycle but got a bit worried due to spotting (even though it was from an ectropion) and because I am getting older so I reduced it to 6 weeks and now to 7 because 6 weeks seemed too short - especially with vaginal progesterone for 12 days! My female doc seemed happy about this.
Dr Currie on this site recommends conti HRT in the first instance because of the risk of endometrial hyperplasia
I hope this helps x
Hurdity x
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Blimey Sara2 and Hurdity that was quick!
Thank you, I will read your replies properly, but just wanted to pop up and say you are amazing to get back so quickly. Thanks ever so much.
Luby :bighug:
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Hi lubylou
No problem - actually I've been working all day and only just come on here - I just go through the list of unread topics I am interested in, in the order in which they appear - so I answer the latest ones first if you see what I mean!
Hurdity x :)
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When HRT was first used in the 1960s it was oestrogen-only. There is a lot of evidence now about the effect progestins have on breast cancer- ie more cases with combined HRT than oestrogen-only. There is still a debate about whether it's dose-dependent or if the type of progestin is a factor too. There is some research which shows that progesterone is less of a risk than synthetic progestins. I've included something here from one paper which incidentally raises the comparison between the risks of endometrial cancer and breast cancer.
Here we are...
an extract from the paper on the effects of different progestogens
Progestins and progesterone in hormone replacement therapy and the risk of breast cancer
Carlo Campagnoli,1,* Françoise Clavel-Chapelon,2 Rudolf Kaaks,3 Clementina Peris,1 and Franco Berrino4
Author information ► Copyright and License information ►
In accord with trial results, almost all observational studies published over the last 5 years have also reported an increase in BC risk associated with progestin use in HRT [11,13–20,38,39,43,44,139]. The reported increase in risk was 2–4 times greater than that associated with the use of unopposed estrogen (Tables 4 and and5).5). Furthermore, although there were exceptions [11,16,18,19], most studies providing information on the two regimens of progestin addition [14,15,17,38,39,139] found that the risk was greater with continuous-combined than sequential regimen (Table 6).
Estrogen plus progestin therapy and breast cancer: consequences of the sequential regimen (sEPT) and the continuous-combined regimen (ccEPT) (observational studies)
These findings, which are consistent with the ‘estrogen augmented by progesterone' hypothesis [23–25] prompted suggestions that alternative ways of protecting the endometrium – that have no or reduced effects on breast tissue – should be tried, e.g. the use of an intra-uterine device with a progestin or the intravaginal administration of progesterone [23]. The elimination of progestins from HRT preparations was even suggested, since the increased risk of endometrial cancer with unopposed estrogens would be more than counterbalanced by the reduced risk of BC [18].
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Thanks Sarah - yes I've seen this paper. The most important point re breast cancer risk though is in the conclusion:
The balance of the in vivo evidence is that progesterone does not have a cancer-promoting effect on breast tissue. This provides a biological rationale for the finding that oral micronized progesterone added to estrogens in sequential or cyclic-combined regimens does not increase the risk of BC [26]. The greater BC risk persistently related to the use of HRT preparations containing estrogen and synthetic progestins seems in all likelihood due to the regimen and/or to the kind of progestin used. The “non-physiological†continuous-combined regimen, could increase the risk because it does not allow sloughing of lobular duct epithelium (such as occurs when progesterone declines at the end of the normal menstrual cycle). More importantly, many of the progestins used have several non-progesterone like actions that potentiate the proliferative effect of estrogens on breast tissue and estrogensensitive cancer cells. We therefore suggest that when HRT is indicated, preparations containing progesterone and not a synthetic progestin should be used, according to a sequential or cyclic-combined regimen. In this way the risk of endometrial cancer is minimized without increasing the risk of BC.
In other words - it is suggested that to minimise breast cancer risk, then natural progesterone should be used rather than synthetic progestogens - but either on a continuous combined or a cyclical regime.
The starting point for this is the biology and mechanism of action (of progesterone on breast tissue) rather than the statistics, from which it is always difficult to disentangle cause and effect from simple correlation.
Interesting that they refer to continuous combined HRT as non-physiological, when that is what happens during pregnancy - ie continuous high levels of progesterone for 40 weeks for substantial parts of our life (well that's what we would be doing in the absence of contraception!).
To minimise the risk of endometrial cancer then theoretically the ideal regime is continuous combined (I have been told).
As always the most important point is that there is increasing evidence from so many different sources that bio-identical, transdermal HRT is the safest form to be taking long term - as I am always saying!!!!
Hurdity x
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The effects of high progesterone during 40 weeks of pregnancy several times over a lifetime could be offset by positive changes to the breasts with breast feeding ( which is what women would do if they had lots of children in the past.)
Would you agree that endometrial cancer caught early has a better outcome for most women than breast cancer? not that any of us want either!
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Sara2 and Hurdity
I have read and reread your responses to my post and done some searching around on the internet.
Hurdity when you say you were on a 2 month cycle and then reduced it to 6 weeks and now to 7 because 6 weeks seemed too short do you mean that you had a bleed evry 2 month and then reduced to a bleed every e 7 and 6 weeks ? If I have understood that right, which types of HRT give this flexibility? I cannot see what HRT tablet preparations on the menu would give that flexibility. So am I right this is a combination of a patch /gel regime (I have to say I am still trying to get my head around the Oestrogel and Utrogestan.
Sara2, I would never say to my GP that another Dr had said xyz, my profession was all about confidentiality and respecting my clients ( and a no name no pack drill approach). Nor would I disrespect my GP's expertises by implying I know more than she. I am tending to the view that I should not be on Premique. The gynaecologist I saw was not a menopause specialist and old school. I wasn't given any reason as to why I was prescribed Premique. Mind you I didn't ask either! The more I have read and looked back over the last two years on the Premique low dose, the more I think this is not right for me. I am vegan and have big issue with the ethics of producing a foal to make the CEE (I don't drink milk because I am not keen on calves being taken from their mums and the rest...............)
Anyway I guess you might be expecting this question. I have not been able to find the studies you refer to which show that taking continuous HRT with a synthetic progestogen gives the highest risk of any HRT combination. I would like to read those and add them to the other information I have found about why the CEE/MPA is perhaps not a great combination.
To everyone,
I cannot thank you all enough, just a few weeks ago I was struggling with all the different terminology, let alone making sense if it all but I think I am getting their now so I can have a productive conversation with my GP. Did anyone here the item on BBC radio 4 Woman's Hour about the research at Manchester University regarding high breast density and breast cancer? You can download it as a podcast. I think it was transmitted on the 12 March
LubyLou
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Ok you two (Sara" and Hurdity) you have lost me again in your last two posts. But I assume the report you are discussing is the one I found earlier this evening at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1974841/
I don't think I will ever get to the point I fully understand all the details and complexities.
To be honest i just want to be prescribed something which will give me a quality of life back so I can spend good quality time with my husband and friends! But in order to get to that place I need to understand my options.
Lubylou
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Hi Lubylou
Yes that is the right paper. If you just read the beginning and the conclusion and maybe look at the graphs it gives you some facts.
The combination of gel and Utrogestan ( or another progestin such as norethisterone- which is synthetic) allow you to tailor the bleed in terms of cycles. Patches would do the same though I've never used those.
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Hi lubylou
To answer your question, yes by cycle length I mean a bleed every X weeks. so a normal 4 week cycle is a bleed every 4 weeks. I now have a bleed/cycle every 6-7 weeks depending on when I time the progesterone (sometimes it depends what I'm doing and when I'm going away).
There is no licensed method that gives this flexibility - I am choosing to do this off license from what I've learnt over the years, reading papers and discussing with women on this forum and what their consultants have been prescribed. I first went to a longer cycle in 2011 when I started using Utrogestan.
However I did say that my GP was happy when I told her I was hasving a two monthly cycle - although this isn't written on my prescription which says "Use as directed" !!
Really it is advisable to alter the regimes only under medical supervision.
As I think I said below I use Estradot patches (for 7 years) and Utrogestan but as Sarah says you can also use gel. You can also take estrogen only tablets with Utrogestan separately. I think it's already been pointed out the Tridestra is the only licensed long cycle HRT which is why you can't see the otheres listed!
Hurdity x
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Hurdity and Sara2
Thanks for replies, more good information for me to consider. Wouldn't it be nice of GPs were able to have the training to acquire even 50% of the combined knowledge and information I have got from this site and the ladies who post on it.
Somewhere I found a research article which said that “CEE is associated with higher levels of estrone (E1), which is the most carcinogenic form of estrogen†but I cannot find it now, do you have any idea what it is or where I might re-find it?! Of course it might be well out of date in terms of current thinking on CEEs.
It is clearly a specialism and given most GPs have to have a wide knowledge about many and varied medical and diagnostic matters, the health system cries out for an arrangement whereby each large GP practise and / or by geographical areas women can have easy access to a menopause specialist Dr or nurse. My guess is that to access this specialism expertise is either a postcode lottery or dependant on a person's having a large enough purse to find an expert and pay privately.
Lubylou
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Morning ladies,
I am currently 5 days into my first period for 7 months, it is the first period I've had on the long cycle HRT.
It has totally floored me, horrendous pain which pain killers didn't move for around 9 hours, all in my back, legs and belly.
I've had to take time off work and it's left me feeling anxious and low, I'm hoping this is just the hormones and will pass.
I am reluctant to continue with the long cycle and I am now thinking of giving up completely on HRT.
I also take citalopram 30mg daily.
Does anyone have any suggestions and/or advice please?
Thanks
Shellb
xXx
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First- just to say that I sympathise- it's a horrible feeling.
I think your only option is to try a shorter cycle- so maybe 6 weeks next time?
How far into the cycle did you take the Norethisterone?
Definitions of cycle length eg. a 6-7 week cycle- to me this means taking the progestin at end of week 4, so a bleed on the 6th week. But it could also mean take the progestin at week 6 and bleed 2 weeks after that
Anyway- whatever you are doing, take the Norethisterone several week earlier.
you have to ask yourself if the benefits you are having are worth sticking with, or if by stopping HRT altogether you are throwing the baby out with the bath water.
Depends how much you feel you benefit from HRT and if it's worth trying to find cycle length that suits you.
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Hi shellb
Sorry to hear about the heavy bleed - I think we did discuss this as a possibility elsewhere. 3 months is a long time for oestrogen to build up and it all must come away. Norethisterone is the most powerful progestogen so I imagine it is quite brutal in its effects! I only used it briefly for about 3 months when I first went onto HRT ( sequi patches) but it gave me bad migraines so I stopped.
I can't remember from your other posts what else you've tried and what the options are but I presume you've read this thread and seen what I am on (6-7 week cycle)? Provided there is nothing wrong with your womb lining ( fibroids, polyps etc) then the bleed after this length of time should not be too great and I think you are post-menopausal? If you are still peri then the amount of bleed may still be somewhat unpredictable but will reduce as you get closer to actual menopause and you hormone levels fall.
Hurdity x
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Hi ladies and thanks again for replying to me.
I do have fibroids which I don't think my doctor takes into account, I am still peri as far as I know.
I just want to get the whole thing sorted it's been up and down now for 2 years of trying different types of HRT.
I think I am going to visit the doctor again once thighs have settled as I just can't face her right now.
xXx